Provider Demographics
NPI:1821138330
Name:PEDERSEN, TED T (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:T
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9399
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-9399
Mailing Address - Country:US
Mailing Address - Phone:661-325-4446
Mailing Address - Fax:661-322-9313
Practice Address - Street 1:3900 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0600
Practice Address - Country:US
Practice Address - Phone:661-325-4446
Practice Address - Fax:661-322-9313
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-112765OtherFED ID NUMBER
CAT05799Medicare UPIN
CA77-112765OtherFED ID NUMBER